GeriPal - A Geriatrics And Palliative Care podcast

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Vor neun Jahren hinzugefügt

Inhalt bereitgestellt von GeriPal, Alex Smith, and Eric Widera. Alle Podcast-Inhalte, einschließlich Episoden, Grafiken und Podcast-Beschreibungen, werden direkt von GeriPal, Alex Smith, and Eric Widera oder seinem Podcast-Plattformpartner hochgeladen und bereitgestellt. Wenn Sie glauben, dass jemand Ihr urheberrechtlich geschütztes Werk ohne Ihre Erlaubnis nutzt, können Sie dem hier beschriebenen Verfahren folgen https://de.player.fm/legal.

This Is Woman's Work with Nicole Kalil

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Grown-Up Goals: The 5 Pillars Of Being A Healthy Adult with Michelle Chalfant | 317 35:24

vor 9 Tagen35:24

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Let’s talk about adulting— actual adulting. Not just paying bills or keeping a houseplant alive, but the kind that involves emotional maturity, healthy boundaries, and conscious self-leadership. Because let’s be honest, most of us weren’t taught how to be fully functioning adults… and it shows. Joining us is Michelle Chalfant , licensed therapist turned holistic life coach, creator of The Adult Chair® model, and author of the new book The Adult Chair: Get Unstuck, Claim Your Power, and Transform Your Life . With millions reached through her podcast, coaching programs, and retreats, she’s here to walk us through the five pillars of being a healthy, grounded adult. Here’s the truth: being an adult isn’t about checking boxes or pretending you’re fine. It’s about owning your truth. Feeling your feelings. Practicing compassion without letting yourself off the hook. It’s about setting firm boundaries—with no need for justification—and recognizing that your triggers are not flaws, they’re clues. None of us were handed a guidebook for how to grow up emotionally. We inherited patterns from people who were figuring it out as they went. But what Michelle shares today is empowering: it’s never too late to unlearn what no longer serves you and become the adult you were meant to be. Whether you’re starting this work or knee-deep in your personal development era, this episode will meet you where you are—and help you move forward with clarity, self-trust, and strength. Connect with Michelle: Website: https://theadultchair.com/ Book: https://theadultchair.com/book IG: https://www.instagram.com/themichellechalfant/?hl=en FB: https://www.facebook.com/@TheMichelleChalfant/ YouTube: https://www.youtube.com/c/michellechalfant Related Podcast Episodes: How To Build Emotionally Mature Leaders with Dr. Christie Smith | 272 Boundaries vs. Ultimatums with Jan & Jillian Yuhas | 297 Gentleness: Cultivating Compassion for Yourself and Others with Courtney Carver | 282 Share the Love: If you found this episode insightful, please share it with a friend, tag us on social media, and leave a review on your favorite podcast platform! 🔗 Subscribe & Review: Apple Podcasts | Spotify | Amazon Music Learn more about your ad choices. Visit megaphone.fm/adchoices…

GeriPal - A Geriatrics and Palliative Care Podcast

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A geriatrics and palliative care podcast for every health care professional. We invite the brightest minds in geriatrics, hospice, and palliative care to talk about the topics that you care most about, ranging from recently published research in the field to controversies that keep us up at night. You'll laugh, learn and maybe sing along. Hosted by Eric Widera and Alex Smith. CME available!

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GeriPal - A Geriatrics and Palliative Care Podcast

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364 Episoden

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GeriPal - A Geriatrics and Palliative Care Podcast

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Transgender Health, Aging, and Advocacy: A Podcast with Noelle Marie Javier and Jace Flatt 48:24

vor 11 hours48:24

48:24

Happy Pride Month GeriPal listeners! Transgender issues are in the news. Just today (June 17th) as we record this podcast: Ezra Klein released a wonderful interview with Sarah McBride , the first openly transgender member of congress A judge ruled that cuts to NIH grants focused on minority groups, including transgender people, were illegal and ordered the government to restore funding. It’s Pride month, and our guests remind us of the leadership of two trans women in the Stonewall riots, which started the modern fight for LGBTQI+ rights and liberation. Today’s guests are Noelle Marie Javier, a geriatrician and palliative care doc who tells her story of transitioning as a faculty member at Mt. Sinai in New York, and Jace Flatt, who started their journey as a gerontology researcher at UCSF and is now faculty at UNLV. Jace was in the news recently for having multiple federal grants cancelled because they included transgender participants. We cover many topics, including: Terminology: gender identity, sexual orientation, gender expression, transgender, nonbinary, intersex, what’s in LGBTQI+ Gender affirming care Major health and medical issues associated with aging as a transgender person Allostatic load Accelerated aging What can clinicians do - pointers, pearls, and attitudes Dementia risk Caregiver issues Hormone replacement therapy at the end of life Sexual orientation and gender identity (SOGI) data, what is it, how to collect it respectfully and safely Mentioned: Harvey Chochinov’s Dignity Therapy question , and our prior podcast on LGBT Care for older adults and serious illnes s with Carey Candrian and Angela Primbas So pleased to sing True Colors by Cyndi Lauper, with Kai on guitar for those of you listening to the podcast. -Alex Smith Many links! - Rainbows of Aging : Jace Flatt’s research site. - LGBTQcaregivers - Callen-Lorde gender affirming trans health services - GLMA : organization for health professional advancing LGBTQ+ equality - Center of Excellence for Transgender Health at UCSF - World Professional Association for Transgender Health - Sage advocacy services for LGBTQ+ Elders : focus on impact of Medicaid cuts - Trans bodies, Trans selve s: resource guide…

GeriPal - A Geriatrics and Palliative Care Podcast

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What You Should Know About Radiation Oncology: A Podcast with Anish Butala, Emily Martin and Evie Kalmar 49:44

vor 7 Tagen49:44

49:44

If you’re anything like me, you might find the process of what happens to patients when they visit a radiation oncologist somewhat mysterious. During my training, I didn’t receive much education about radiation oncology, and I’m not entirely sure what some of the terms mean (hypofractionated means fewer sessions, right?). Well, today’s podcast aims to clear up all these uncertainties. We’ve invited Anish Butala, the Chief of the Palliative Radiotherapy Service at Penn Medicine , and Emily Martin , a palliative care doctor and past president of the Society for Palliative Radiation Oncology (SPRO), to explain everything we should know about radiation oncology. Additionally, Evie Kalmar , who suggested today’s topic, will join us as one of our guest hosts. Tune in and we will walk you through the patient’s journey from the initial planning visit to the final treatment, discuss common indications like bone and brain metastases, hear about when to consider steroid therapy, and highlight radiation therapy emergencies.…

GeriPal - A Geriatrics and Palliative Care Podcast

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Implementing Palliative Care in Nursing Homes 48:06

vor 14 Tagen48:06

48:06

The need for better palliative care in nursing homes is significant. Consider this: the majority of the 1.4 million adults residing in U.S. nursing homes grapple with serious illnesses, and roughly half experience dementia. Many also suffer from distressing symptoms like pain. In addition, about 25% of all deaths in the United States occur within these facilities. Despite these substantial needs, specialized palliative care beyond hospice is rare in nursing homes. Furthermore, only about half of nursing home residents nearing the end of life receive hospice care. So, how can we improve palliative care for individuals in nursing homes? Today's podcast explores this crucial question with three leading experts: Connie Cole, Kathleen Unroe, and Cari Levy. Our discussion delves into: The specific palliative care needs of nursing home residents. How to think about primary and specialized palliative care in this setting. The obstacles hindering referrals to palliative care services. Practical strategies to overcome these barriers and enhance care. We also take a dive into these 2 articles that Connie first authored: Palliative care in nursing homes: A qualitative study on referral criteria and implications for research and practice. JAGS 2024 Nursing Home Palliative Care Referral Process, Barriers, and Proposed Solutions: A Qualitative Study. 2024 If you are interested in learning more, check out some of our other palliative care in nursing home podcasts including: Discussion of a primary palliative care multinational trial with Lieve Van den Block Understanding the variability in nursing home care A podcast on Palliative Rehab?!? with Ann Henshaw, Tamra Keeney, and Sarguni Singh…

GeriPal - A Geriatrics and Palliative Care Podcast

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Lucid Episodes: Andrea Gilmore-Bykovskyi & Andrew Peterson 48:55

vor 21 Tagen48:55

48:55

Have any of you watched the movie “ The Notebook ”? At the end, one of the characters, who has dementia, experiences an episode of lucidity. When I watched it, between tears (I’m a complete softie) I remember thinking, “Oh no! This will give people false hope! That their loved one is ‘in there.’ If only they could find the right key to unlock the lock and let them out.” Today we talk about lucid episodes and what they might mean to the person with dementia, their family and loved ones, to philosophers, to clinicians, to neuroscientists. Our guests are Andrea Gilmore-Bykovskyi, a nurse researcher, and Andrew Peterson, a philosopher. We had a wide ranging discussion that touched on (among many things): A consensus definition developed at an NIH conference, organized by the recently retired NIA program officer Basil Eldadah (we will miss you Basil!). Andrew complicates this definition , stating is raises more questions than answers. Hospice nurses know that terminal lucidity “is a thing” and have pretty much all seen it Family and caregiver stories of lucid episodes and what they meant to them, including early glimpses into a study Andrea is doing using video to capture episodes and show them to family. Potential for experiences to elicit “false hope”, misunderstanding/misinterpreting, and changing say code status from DNR to full code ( rare but happens ). Sam Parnia ’s work on brain activity during CPR and near death episodes Ethical issues these lucid episodes raise Should clinicians treat people with dementia as always lucid? Having some level of awareness? Parallels between how we treat people with advanced dementia, who may or may not be lucid, and how we treat AI , who may or may not be conscious, or experiencing paradoxical lucidity on their way to full consciousness. I try to say please and thank you to the AI I interact with other than Alexa, who is obviously way behind. The Age of Aging podcast episode on lucidity , featuring Anne Bastings, Jason Karlawish, Elizabeth Donnarumma, and Justin Clapp Was Andrew’s song choice, “I can see clearly now” better than Eric’s suggestion “Silent Lucidity” by Queensryche? Enjoy! -Alex Smith…

GeriPal - A Geriatrics and Palliative Care Podcast

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Music as Medicine: Jenny Chen, Tyler Jorgensen, & Theresa Allison 42:03

vor 28 Tagen42:03

42:03

As you know, dear listeners, I love music. We start each podcast with a song in part to shift the frame, taking people out of their academic selves and into a more informal conversation. Well, today’s guests love music at least as much if not more than me, and they each make a strong case for music as medicine. Jenny Chen is a palliative care fellow at Yale who regularly sings for her seriously ill patients. Look for Jenny to potentially appear on the show America’s Got Talent (no lie). Tyler Jorgensen not only plays music for his patients, starting out with just pulling up a tune on his iPhone, he and others at UT Austin and Dell med now wheel a record player into patients rooms and play vinyl, taking patients back to the sounds and routines - think taking the record out of the sleeve, placing the needle in the groove - of younger days. You can here Tyler and I having a great time singing together and sharing stories around his podcast My Medical Mixtape . And Theresa Allison is a geriatrician and ethnomusicologist who studies the role of music for people with dementia. The ability to appreciate, recognize, and engage with music is preserved even until late stages of dementia, and Theresa is examining how music can be useful from the time of diagnosis, not only for the person with dementia, but their caregivers. Many links today, including: - Alive Inside Movie and Music and Memory movement - Music and Creativity in Healthcare Settings - book by Hilary Moss -Tyler Jorgensen’s article on Bringing Music to patients at the Bedside in JGIM -Tyler’s reflection/story comparing palliative medicine to jazz - something I arrived at independently and tell all new trainees! This is not highly scripted orchestral music, people, it’s Jazz. -S ystematic review of music (and prognosis) in palliative care -Review of music and dementia interventions (Theresa Allison author) -Theresa Allison’s paper on Music Engagement in Dementia Caregiver Relationships in Gerontologist - Jenny Chen’s YouTube channel.…

GeriPal - A Geriatrics and Palliative Care Podcast

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Nudges for Prognosis and Comfort Care in the ICU: Kate Courtright, Scott Halpern, & Jaspal Singh 48:27

vor 5 weeks48:27

48:27

Our main focus today was on nudging critical care clinicians to consider a more palliative approach to care. Our guests are all trained in critical care: Kate Courtright, Scott Halpern, and Jaspal Singh. Kate and Scott have additional training in palliative medicine. To start. we review: What is a nudge? Also called behavioral interventions, heuristics, and cognitive biases. Prior podcasts on the ethics of nudging , and a different trial conducted by Kate and Scott in which the default for hospitalized seriously ill patients was to receive a palliative care consult . What is sludge? I’d never heard the term, perhaps outside of Eric’s pejorative reference to my coffee after adding copious creamers, flavoring, and sweeteners. Sludge is apparently when you create barriers or extra work for someone. For example, putting the healthy food at the back of the grocery store is sludge; making an applicant for health insurance climb the flight of stairs to the office - weeding out those less fit - is also sludge. Prior-auth forms? Sludge. Examples of nudges, some based in health care, others in coffee. This specific study , published in JAMA Internal Medicine, was conducted in 17 ICUs in North Carolina. Many were community hospitals. Participants were critically ill and intubated. Clinicians were randomized to 4 groups: Usual care Prognosis nudge - EHR prompt asking, do you think your patient will be alive in 6 months? This is called a focusing effect Comfort care nudge - EHR prompt asking if they’d offered comfort-focused care. This is called accountable justification - an appeal to standards of care for critically ill patients endorsed by multiple professional societies. Both the prognosis and comfort care nudge. A few key points of discussion: Is an EHR prompt a nudge or sludge? The intervention was a negative study for the primary outcome, hospital length of stay. Why? The prognosis nudge did nothing. What to make of that? Would you think an EHR nudge to consider prognosis might move the needle, at least on some outcomes? The nudge toward offering comfort care led to more hospice and early comfort-care orders. Is this due to chance alone, given the multiplicity of secondary outcomes examined? Or is it a tantalizing finding that suggests a remarkably low cost EHR based nudge might, on a population level, lead to critical care clinicians offering comfort care and hospice more frequently? Imagine ! - Alex Smith…

GeriPal - A Geriatrics and Palliative Care Podcast

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Psilocybin in Serious Illness: A Podcast with James Downar, Ali John Zarrabi and Margaret Ross 46:57

vor 6 weeks46:57

46:57

We’ve covered psychedelics on the podcast before—first in 2019 with Ira Byock, where we explored their potential role in medicine , and then again in 2023 with Stacy Fischer, Brian Anderson, and Theora Cimino, focusing on the reasons to approach psychedelic use in patients with caution . In today’s episode, we’re taking a closer look at the current state of the science around one specific psychedelic: psilocybin. We'll discuss three recent clinical trials involving patients with serious illness, joined by our guests James Downar , Ali John Zarrabi , and Margaret Ross . We begin with a refresher on psilocybin—what it is, how it might work, what conditions it may help treat (including demoralization), and how it’s typically administered. What makes this episode especially compelling is our deep dive into the three studies, which highlight two different approaches to using psilocybin: daily microdosing, similar to traditional antidepressants, and a more intensive model known as psilocybin-assisted therapy. This latter approach involves three structured phases—preparation, the dosing session, and post-session integration with trained therapists.…

GeriPal - A Geriatrics and Palliative Care Podcast

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HIV, Aging, and Palliative Care: Peter Selwyn and Meredith Greene 48:59

vor 7 weeks48:59

48:59

Peter Selwyn, one of today’s guests, has been caring for people living with HIV for over 40 years. In that time, care of people with HIV has changed dramatically. Initially, there was no treatment, then treatments with marginal efficacy, complex schedules, and a tremendous burden of side effects and drug-drug interactions. The average age at death was in the 30s. Now, more people in the US die with HIV rather than from HIV. Treatment regimens are simplified, and the anti-viral drugs are well tolerated. People are living with HIV into advanced ages. The average age at death is likely in the 60s. Nearly half of people living with HIV are over age 55. One in 10 people with newly diagnosed HIV is an older adult. Our second guest, Meredith Greene, is a geriatrician and researcher who focuses on care of older adults living with HIV, in the US and Africa. On today’s podcast we discuss: Implications of aging with HIV for clinical care Loneliness and social isolation among older adults living with HIV Persistence of stigma Need to consider HIV in the differential diagnosis for older adults Screening for HIV Screening for osteoporosis in people living with HIV Dementia and cognitive impairment risk in people living with HIV When to stop anti-virals near the end of life Toward the end we speak to the moment. More older adults live with HIV in SubSaharan Africa and the global South than anywhere else in the world. Funding for research and clinical care is at risk, as USAID and PEPFAR (which is under USAID), are shuttered. Millions of lives are at stake. Meredith wore a shirt that said Silence=death . Eric gave me the hook during my live cover of One, by U2, a song released in 1992 whose proceeds went entirely to AIDS research. I couldn’t help it, forgive me dear listeners, I had to do a longer than usual cut at the start! -Alex Smith Useful links: Peter's article on the evolution of HIV: https://link.springer.com/article/10.1007/s11524-011-9552-y Peter’s book Surviving the Fall: Personal Journey of an AIDS Doctor PEPFAR: Global Health Policy | KFF Articles: Geriatric Syndromes in Older HIV-Infected Adults - PMC Loneliness in Older Adults Living with HIV Management of Human Immunodeficiency Virus Infection in Advanced Age https://pmc.ncbi.nlm.nih.gov/articles/PMC3684249/ About Act-up for those who might know the Silence=Death t-shirt reference: https://www.npr.org/2021/06/16/1007361916/act-up-a-history-of-aids-hiv-activism https://www.newyorker.com/magazine/2021/06/14/how-act-up-changed-america…

GeriPal - A Geriatrics and Palliative Care Podcast

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Potentially Unsafe Low-evidence Treatments: Adam Marks, Laura Taylor, & Jill Schneiderhan 45:26

vor 8 weeks45:26

45:26

More and more people are, “ doing their own research. ” Self-identified experts and influencers on podcasts (podcasts!) and social media endorse treatments that are potentially harmful and have little to no evidence of benefit, or have only been studied in animals. An increasing number of federal leaders have a track record of endorsing such products. We and our guests have noticed that in our clinical practices, patients and caregivers seem to be asking for such treatments more frequently. Ivermectin to treat cancer. Stem cell treatments. Chelation therapy. Daneila Lamas wrote about this issue in the New York Times this week -after we recorded - in her story, a family requested an herbal infusion for their dying mother via feeding tube. Our guests today, Adam Marks, Laura Taylor, & Jill Schneiderhan, have coined a term for such therapies, for Potentially Unsafe Low-evidence Treatments, or PULET. Rhymes with mullet (On the podcast we debate using the French pronunciation, though it sounds the same as the French word for chicken). We discuss an article they wrote about PULET for the American Journal of Hospice and Palliative Medicine, including: What makes a PULET a PULET? Key ingredients are both potentially unsafe and low evidence. If it’s low evidence but not unsafe, not generally an issue. Think vitamins. If it’s potentially unsafe, but has robust evidence, well that’s most of the treatments we offer seriously ill patients! Think chemo. What counts as potentially unsafe? They include what might be obvious, e.g. health risks, and less obvious, e.g. financial toxicity. What counts as low-evidence? Animal studies? Theoretical only? Does PULET account for avoiding known effective treatments? Do elements of care that are often administered to seriously ill patients count? Yes. Think chemotherapy to imminently dying patients, or CPR. How does integrative medicine fit in with this? Jill Schneiderhan, a family medicine and integrative medicine doc, helps us think through this. How ought clinicians respond? Hint: If you’re arguing over the scientific merits of a research study, you’re probably not doing it right. Instead, think VitalTalk , REMAP, and uncover and align with the emotion behind the request. Does the approach shift when it’s a caregiver requesting PULET for an older relative who lost capacity? How about parents advocating for a child? For more, Laura suggests a book titled, How to Talk to a Science Denier . And I am particularly happy that the idea for this podcast arose from my visit to Michigan to give Grand Rounds , and the conversations I had with Adam and Laura during the visit. We love it when listeners engage with us to suggest topics that practicing clinicians find challenging. And I get to sing Bon Jovi’s Bad Medicine, which is such a fun song! -Alex Smith…

GeriPal - A Geriatrics and Palliative Care Podcast

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Loss of DEI Hurts Everyone: Farah Stockman, Ali Thomas, Ken Covinsky 47:18

vor 9 weeks47:18

47:18

I read Farah Stockman’s article in the NYT on why attacks on DEI will cost us all , and thought, “Yes, and ‘everyone’ includes harm to our healthcare workforce, our patients, and their families.” So we’re delighted that Farah Stockman, pulitzer prize winning journalist, author of American Made: What Happens to People When Work Disappears , and editorial board member at the New York TImes joins us to set the bigger picture for this discussion. Farah provides clear examples from the Biden administration, in which having the most diverse cabinet in history was critical to building bridges, empathy, and inspiring others to feel included. We are also pleased to welcome Ali Thomas, a hospitalist, member of the Baha'i Faith, leader of anti-racism efforts in the Pacific Northwest, and founder of the BIPOC Health Careers Ecosystem . Ali talks about the history of affirmative action, which started as a program for Whites , the importance of diversity in the healthcare workforce , the history of allyship and cross cultural collaboration, and his own efforts to provide opportunity and support for historically oppressed groups in his own community to obtain healthcare careers. And Ken Covinsky, avid baseball fanatic, joins us and notes that the day we record (April 15) is Jackie Robinson day . Many may be familiar with the story of Jackie Robinson breaking the color barrier in major league baseball in 1947, but may not be aware of the tremendous adversity Jackie Robinson faced, and persistence he displayed, off the field. We address many things, including: The movement in Corporate America and institutes of higher education to implement DEI programming in the wake of George Floyd The general agreement in America of the value of diversity, and disagreement, unpopularity, and backlash about DEI as it was implemented How the pursuit of diversity and excellence are not in tension, they are aligned and necessary for each other What we can do to build bridges across differences There was so much we hoped to talk about and didn’t get to, but I will link to now, including: Ali’s mom’s personal history with and study of school desegregation in South Carolina , Farah’s mom’s pioneering work as a speech language pathologist , and Ken’s perspectives on the importance of studying ageism and racism in research . What a Wonderful World could be sung in irony at this moment. I hope we all take it literally, with the hope this podcast ends with. The podcast follows the arc towards hope of this video on Race Amity from the National Center for Race Amity, courtesy of Ali Thomas (his dad is featured). -Alex Smith…

GeriPal - A Geriatrics and Palliative Care Podcast

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RCT of PC in ED: Corita Grudzen, Fernanda Bellolio, & Tammie Quest 50:34

vor 10 weeks50:34

50:34

Early in my research career, I was fascinated by the (then) frontier area of palliative care in the emergency department. I asked emergency medicine clinicians what they thought when a patient who is seriously ill and DNR comes to the ED, and some responded, (paraphrasing), what are they doing here? This is not why I went into emergency medicine. I went into emergency medicine to act. I can’t do the primary thing I’ve been trained to do: ABC, ABC, ABCs. Most emergency providers wanted to do the right thing for seriously ill patients, but they didn’t have the knowledge, skills, or experience to do it. Today we focus on an intervention , published in JAMA, that gave emergency clinicians basic palliative care knowledge, training, and skills. We talk with Corita Grudzen and Fernanda Bellolio about their cluster stepped wedge randomized trial of a palliative care intervention directed at emergency clinicians . They got training in Vital Talk and ELNEC. They got a decision support tool that identified hospice patients or those who might benefit from a goals of care discussion. They got feedback. So did it matter? Hmmm….it depends. We are fortunate to have Tammie Quest, emergency and palliative trained and long a leader in this space, to help us unpack and contextualize these findings. Today we discuss: Why the study was negative for the primary (hospitalization) and all secondary outcome (e.g. hospice use). Why to emergency clinicians, this study was a wild success because they had the skills they wanted/needed to feel like they could do the right thing (during the onset of Covid no less). Why this study was a success due to the sheer size (nearly 100,000 patients in about 30 EDs) of the study, and the fact that, as far as the investigators know, all study sites continue to employ the clinical decision support tool. What is a cluster stepped wedge randomized trial? Were they surprised by the negative findings? How do we situate this study in the context of other negative primary palliative care interventions, outside the ED? E.g. Yael Shenker’s negative study of primary palliative care for cancer , Randy Curtis’s negative study of a Vital Talk-ish intervention , Lieve Van den Block’s negative study of primary PC in nursing homes . Why do so many (most, all??) primary palliative care interventions seem to fail, whereas specialized palliative care interventions have a relatively robust track record of success. Should we give up on primary palliative care? What’s next for primary palliative care interventions in the ED? And if your Basic Life Support training certification is due, you can practice the correct chest compression rate of 110 beats per minute to Another One Bites the Dust. -Alex Smith…

GeriPal - A Geriatrics and Palliative Care Podcast

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GeriPal Takeover! Nancy Lundebjerg and Annie Medina-Walpole 51:34

vor 11 weeks51:34

51:34

Whelp, goodbye folks! Eric and I have been DOGE’d. In a somewhat delayed April Fools, Nancy Lundebjerg and Annie Medina-Walpole have taken over podcast host duties this week. Their purpose is to interview me, Eric, and Ken Covinsky about your final AGS literature review plenary session taking place at the Annual Meeting in Chicago this May (for those attending, our session is the plenary the morning of May 10). We discuss our favorite articles, parody songs, and memories from AGS meetings past, with a little preview of a song for this year’s meeting. We covered: The first parody song I wrote, for AGS 2018 in Orlando , about this article by Nancy Schoenborn on how to discuss stopping cancer screening . Ken’s favorite articles, including The Impact of Rudeness on Medical Team Performance: A Randomized Trial Effect of Exercise Intervention on Functional Decline in Very Elderly Patients During Acute Hospitalization Eric’s favorite article on the effect of chair placement on physicians’ behavior and patients’ satisfaction Tim Anderson’s study on the intensification of older adults’ outpatient blood pressure treatment at hospital discharge Nancy’s favorite topic and parody song , Aducanumab, which won Drug of the Year in 2021. Enjoy! And maybe, just maybe, Eric and I will be reinstated and return as hosts next week… -Alex Smith…

GeriPal - A Geriatrics and Palliative Care Podcast

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Pragmatic Trial of ACP: Jennifer Wolff, Sydney Dy, Danny Scerpella, and Jasmine Santoyo-Olsson 47:04

vor 12 weeks47:04

47:04

A pragmatic trial evaluates the effectiveness of a treatment or intervention in “real-world” clinical practice. Outcomes are typically assessed from available records. Eligibility in pragmatic trials are often broad, and don’t have the exclusions of efficacy studies, which examine treatment effects under highly controlled conditions in highly select populations. Today we are delighted to welcome Jennifer Wolff, Sydney Dy, and Danny Scerpella, who conducted a pragmatic trial of advance care planning (ACP) in primary care practices; and Jasmine Santoyo-Olsson, who wrote an accompanying commentary in JAMA Internal Medicine . We spend the last portion of the podcast discussing the surprising finding of the study. In the primary care practices that received the advance care planning intervention, rates of advance care planning were higher (about double). Shockingly, rates of potentially burdensome intervention (intubation, CPR, etc) were also higher in the advance care planning intervention group. What?!? Not a typo. We spend some time unpacking and contextualizing the potential reasons for this surprising finding, including: Disconnect between relatively low rates of new advance directives (12% in intervention arm vs 7% control) and higher rates of potentially burdensome treatment among decedents (29% in intervention arm vs 21% control). Only 5% of intervention patients received the facilitator led component of the intervention (there were other components, facilitator-led was the most engaged component). Was there really a causal connection between the intervention, new advance directives, and higher rates of potentially burdensome interventions? Potential that care received, though potentially burdensome, was in fact aligned with goals, and might represent goal concordant care . Potential that documenting advance directives without a robust conversation about prognosis might have led to these findings. My goals will differ if I think I probably have 2 years to live vs 10 years. Comparison to a trial Yael Shenker discussed in our podcast on AAHPM/HPNA plenary abstracts (also used the Respecting Choices intervention, outcome differed). Implications for the larger discussion over the value of advance care planning, and additional research into advance care planning. As I say on the podcast, I’m sure Sean Morrison would be delighted to point to these findings as evidence that advance care planning doesn’t work, and in fact may be harmful. And I got to sing in Spanish for the second time. I hope my pronunciation is better than my Urdu , or French ! -Alex Smith…

GeriPal - A Geriatrics and Palliative Care Podcast

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Hastening Death by Stopping Eating and Drinking: Hope Wechkin, Thaddeus Pope, & Josh Briscoe 51:26

vor 13 weeks51:26

51:26

Eric and Alex have featured discussions about complex bioethical concepts around caring for people at the end of life, including voluntarily stopping eating and drinking ( VSED ), and multiple episodes about the ethical issues surrounding medical aid in dying ( MAID ). Recently, discussion has emerged about how these issues intertwine in caring for patients with advancing dementia who have stated that they would not want to continue living in that condition: for those with an advanced directive to stop eating and drinking, how do we balance caring for their rational past self and their experiential current self? Should these patients qualify for medical aid in dying medications? And is there a middle path to provide some degree of comfort while also hastening the end of life? To delve into these questions, we spoke with Hope Wechkin, medical director of EvergreenHealth home hospice, who authored an article describing a process of Minimal Comfort Feeding (MCF) for patients who have expressed an interest in not wanting to live with advanced dementia. MCF, which Hope implemented for one of her hospice patients, serves as a middle way between the discomfort to the patient and caregivers of completely withholding food and fluid, and the current practice of comfort feeding only in which food and fluid are routinely offered to patients even in the absence of a symptomatic benefit. We were also joined by Thaddeus Pope, JD and Dr. Joshua Briscoe, to discuss the topic of voluntarily stopping eating and drinking as a potential bridge to access medical aid in dying medications and their respective articles on the topic. We discussed what makes an illness “terminal”, what goes into assessing capacity for an action as simple as requesting something to drink, and whether the TV show Severance illuminates any of these answers. -Theo Slomoff, UCSF Palliative Care Fellow 2024-25 (guest host) Articles referenced in this discussion: “Mr. Smith Has No Mealtimes”: Minimal Comfort Feeding for Patients with Advanced Dementia by Hope Wechkin et al in JPSM Medical Aid in Dying to Avoid Late-Stage Dementia by Thaddeus Pope and Lisa Brodoff in JAGS Law not loopholes: Medical aid in dying for those with dementia also in JAGS by Joshua Briscoe and Eric Widera Past GeriPal Podcast Episodes on MAID: MAID podcasts https://geripal.org/what-is-going-on-with-maid-in-canada-bill-gardner-leonie-herx-sonu-gaind/ https://geripal.org/conscientous-provision-of-maid-and-abortion-robert-brody-lori-freedman-mara-buchbinder/ https://geripal.org/assisted-dying-podcast-with-lewis-cohen/ https://geripal.org/dilemmas-in-aid-in-dying-podcast-with/ Past GeriPal Podcast Episode about VSED: https://geripal.org/tim-quill-vsed/…

GeriPal - A Geriatrics and Palliative Care Podcast

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The Roots of Palliative Care: Michael Kearney, Sue Britton, and Justin Sanders 48:50

vor 14 weeks48:50

48:50

As far as we’ve come in the 50 years since Balfour Mount and Sue Britton opened the first palliative care at the Royal Victoria Hospital in Quebec, have we lost something along the way? In today’s podcast we welcome some of the early pioneers in palliative care to talk about the roots of palliative care. Sue Britton was the first nurse hired on that palliative care unit. Michael Kearney on a transformational meeting in Cicely Saunders’s office, with Balfour Mount at her side and a glass of sherry. Justin Sanders wants to be sure the newer generations of palliative care clinicians understand the early principles and problems that animated the founders of hospice and palliative care, including: Origins of the word “palliative” - it’s not what I thought! Yes, it means “to cloak,” but there’s more… Whole-person-care Total pain Healing as a process distinct from the deterioration of the body Sympomatologists The patient and family as the unit of care Our guests referenced many articles on this podcast, linked above and below. If you read just one, read Palliative Medicine - Just Another Specialty ? by Kearney. I promise it’s short. 2 pages. Here’s a taste: …While there is an abusive and useless dimension to illness, pain and suffering which needs to be removed if at all possible, there is also potential in such experience…If we in palliative medicine fail to accept this view, a view which allows that there may also be a potential in the suffering of the dying process, if we sell out completely to the literalism of the medical model with its view that such suffering is only a problem, we will be in danger of following a pattern which could significantly limit our scope for development and lead to our becoming ’symptomatologists’, within just another specialty. And love that Jim Croce choice. What’s in a name? I’ve got a name. Enjoy! -Alex Smith Links Link to the McGill National Grand Rounds Series on Palliative Care , Michael Kearney as initial presenter, and registration for future events. No, you don’t need to be Canadian. Canadians are welcoming. Palliative Medicine - Just Another Specialty? In Palliative Medicine By Kearney Joe Wood’s book on Total Pain Balfour Mount’s memoir Ten Thousand Crossroads paper on Healing Connections in JPSM and Healing and Palliative Care in Palliative Medicine Cicely Saunders: A Life and Legacy , by David Clark Self-Care of Physicians Caring for Patients at the End of Life, by Michael Kearney and colleagues in JAMA Perspectives on Care at the Close of Life series Twycross on Readdressing Balance in Hospice…

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